OBJECTIVE: The purpose of this study was to analyze risk factors that are associated with intracranial lesion, and to propose criteria for classification of mild head injury (MHI), and appropriate treatment guidelines. METHODS: The study was based on 898 patients who were admitted to our hospital with Glasgow Coma Scale (GCS) score of 13 to 15 between 2003 and 2007. The patients' initial computerized tomography (CT) findings were reviewed and clinical findings that were associated with intracranial lesions were analyzed. RESULTS: GCS score, loss of consciousness (LOC), age and skull fracture were identified as independent risk factors for intracranial lesions. Based on the data analysed in this study, MHI patients were divided into four subgroups : very low risk MHI patients are those with a GCS score of 15 and without a history of LOC or headache; low risk MHI patients have a GCS score of 15 and with LOC and/or headache; medium risk MHI patients are those with a GCS score of 15 and with a skull fracture, neurological deficits or with one or more of the risk factors; high risk MHI patients are those with a GCS score of 15 with abnormal CT findings and GCS score of 14 and 13. CONCLUSION: A more detailed classification of MHI based on brain CT scan findings and clinical risk factors can potentially improve patient diagnosis. In light of our findings, high risk MHI patients should be admitted and treated in same manner as those with moderate head injury.
Adult ; Brain ; Craniocerebral Trauma ; Glasgow Coma Scale ; Head ; Humans ; Light ; Risk Factors ; Skull Fractures ; Unconsciousness

OBJECTIVE: This study was designed to define the Korean norm values for the Ricketts analysis. METHODS: In this longitudinal study, lateral cephalograms of 31 subjects with normal occlusion were taken biennially from ages 9-19 years. Cephalometric measurements were performed. Parameters for which the 10-year change did not exceed one standard deviation were defined as unchanged. The means and standard deviations for the measured parameters were determined for each age group. RESULTS: No significant changes in growth were observed in the molar relationship, incisor overjet, incisor overbite, mandibular incisor extrusion, interincisor angle, lower incisor tip (B1) to A point-Pogonion (A-PO) plane, upper incisor tip (A1) to A-PO plane, B1 inclination to A-PO, A1 inclination to A-PO, B1 inclination to Frankfurt plane (FH), convexity, lower facial height, facial axis, maxillary depth, maxillary height, palatal plane to FH, cranial deflection, ramus Xi position, or porion location. Continual changes over the 10 years of growth were observed in the maxillary first molar distal position to pterygoid true vertical plane, facial depth, mandibular plane to FH, anterior cranial length, mandibular arc, and corpus length. CONCLUSIONS: Clinicians can apply the Korean norms at age 9 as determined in this study when using the Ricketts analysis. The patient's age at the beginning of treatment and their sex should be taken into consideration when drawing visual treatment objectives.
Axis, Cervical Vertebra ; Growth and Development ; Humans ; Incisor ; Longitudinal Studies ; Molar ; Overbite

We present a patient with spinal epidural arteriovenous fistula presented with subdural hematoma and progressive myelopathy. Transarterial embolization using NBCA results in complete obliteration of fistula without complication. The pathophysiology, angioarchitexture of the lesion and strategy for its cure would be discussed.
Arteriovenous Fistula* ; Fistula ; Hematoma, Subdural* ; Humans ; Spinal Cord Diseases ; Spine

The devices and methods of endovascular recanalization therapy (ERT) have been rapidly developed and changed since PROACT II trial. Emerging as a treatment option in addition to intravenous or intra-arterial thrombolysis, mechanical thrombectomy is currently being further developed and investigated as a potential first-line and stand-alone treatment. This review highlights and summarizes the recent clinical series and trials of the available devices and methods of ERT focusing on the multimodal approach.
Brain ; Cerebrovascular Disorders ; Endovascular Procedures ; Mechanical Thrombolysis ; Stroke ; Thrombectomy ; Thrombolytic Therapy

PURPOSE: Intrahepatic duct stones have been known to be a benign disease but because of the associated serious complications and the high recurrence rate, the management of the hepatolithiasis is very difficult. This purpose of this study was to classify the patterns of intrahepatic duct stones, and to evaluate the effect of surgical treatment according to their type and the residual stones that were present. METHODS: The clinical records of 212 patients who underwent a hepatic resection or drainage procedures between January 1988 and December 2000 were reviewed. RESULTS: We classified the intrahepatic duct stones as being either a localized simple type, a localized complicated type, a diffuse simple type, or a diffuse complicated type. Hepatic resections were performed in 177 (83.5%) cases. Among these we performed a hepatic resection along with drainage procedures in 41 cases (19.3%). In 35 (16.5%) cases, only drainage procedures were performed. Of a total of 25 cases of postoperative residual stones (25 cases), 13 (52%) cases were removed completely or partially by choledochoscopic procedures in 13 (52%) cases and in 15 (60.0%) cases they were removed completely or partially by spontaneous drainages. CONCLUSION: Our conclusions were that the, localized type of the IHD stones were treated successfully by a hepatic resection and the localized complicated type and the diffuse type IHD stones were treated effectively by hepatic resection and drainage procedures which reduced the opportunity for residual stones to develop following an accurate preoperative diagnosis of the location of the stones. Therefore, treatment methods should be individualized for each type of stone and by surgical treatments that combine endoscopic and resolution methods.
Classification* ; Diagnosis ; Drainage ; Humans ; Recurrence

OBJECTIVE: The aim of this study was to evaluate the efficacy of endovascular therapy as a primary treatment for spinal dural arteriovenous fistula (DAVF). METHODS: The authors reviewed 18 patients with spinal DAVFs for whom endovascular therapy was considered as an initial treatment at a single institute between 1993 and 2006. NBCA embolization was considered the primary treatment of choice, with surgery reserved for patients in whom endovascular treatment failed. RESULTS: Surgery was performed as the primary treatment in one patient because the anterior spinal artery originated from the same arterial pedicle as the artery feeding the fistula. Embolization was used as the primary treatment modality in 17 patients, with an initial success rate of 82.4%. Two patients with incomplete embolization had to undergo surgery. One patient underwent multiple embolizations, which failed to completely occlude the fistula but relieved the patient's symptoms. Spinal DAVF recurred in two patients (one collateral development and one recanalization) during the follow-up period. The collateral development was obliterated by repeated embolization, but the patient with recanalization refused further treatment. The overall clinical status improved in 15 patients (83.3%) during the follow-up period. CONCLUSION: Endovascular therapy can be successfully used as a primary treatment for the majority of patients with spinal DAVFs. Although it is difficult to perform in some patients, endovascular embolization should be the primary treatment of choice for spinal DAVF.
Arteries ; Central Nervous System Vascular Malformations ; Embolization, Therapeutic ; Fistula ; Follow-Up Studies ; Humans ; Spine

Simultaneous occurrence of remote intracerebral hemorrhage (ICH) and intracranial aneurysmal subarachnoid hemorrhage is very rare. We report on a case of concurrent hypertensive ICH at the left thalamus and rupture of an intracranial aneurysm at the bifurcation of the single A2 segment of the anterior cerebral artery in a 64-year-old woman, which was clipped previously, with review of the literature. To our knowledge, this is the first case report demonstrating bleeding of previously clipped aneurysm with simultaneous hypertensive ICH. Hypertensive crisis following ICH seems to have provoked rupture of the residual aneurysm.
Aneurysm ; Anterior Cerebral Artery ; Cerebral Hemorrhage ; Female ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Intracranial Hemorrhage, Hypertensive ; Middle Aged ; Rupture ; Subarachnoid Hemorrhage ; Thalamus

No Abstract

The authors experienced 32 cases of reoperation due to persistent or recurred symptoms who had once low back operation due to herniated lumbar disc. The results were summarized as follows: 1) The reoperated cases were most common in 5th decade(31.3% ) and 2nd most common in 4th decade(28.1%) of age, and the male to female ratio was 2:1. 2) The lesion sites of reoperated cases were L4-5 space(68.8%), L5-S1 space(18.8%), multiple space(9.4%) and L3-4 space(3.1%) in orders. 3) The symptom-free interval between 1st and 2nd operation were 1-5 years(34.4%), 6-10 years(15.6%) and 2-6 months(12.5%) in orders. The longest interval were above the 11 years (21.9%) and the shortest interval were below the 1 month(15.6%). 4) The main pathologic findings of reoperated 32 cases were epidural fibrosis(31.2%), incomplete disc removal+epidural fibrosis(31.2%), new disc herniation(21.8%), foraminal stenosis(9.4%) and opposite site herniation(6.3%) in orders. 5) The results of 32 reoperated cases were good(43.7%), excellent(21.8%), fair(18.7%) and poor(15.6%) in orders.
Female ; Humans ; Intervertebral Disc* ; Male ; Reoperation

PURPOSE: To determine, by means of a phantom study, the distortion-related factors and appropriate iodine concentration for three-dimensional reconstruction rotational angiography. MATERIALS AND METHODS: Four phantoms were created: crossed metal rods, one metal rod, one contrast rod, and a contrast rod under water. Iodine concentrations were 300, 250, 200, and 150 Img/ml, respectively. For each phantom, rotational angiography was performed in the rotational, right-angled (90 degree to rotational), intermedial (45 degree), close to rotational (20 degree), and close to right-angled (70 degree) planes. Two-dimensional projection images were transferred to a workstation at which 3D images were produced using the volume rendering technique. Image quality in each plane was evaluated in terms of opacity, homogeneity, and margin sharpness, which were graded as low, intermediate or high by two neuroradiologists who used images obtained in the right-angled plane as the standard reference. The same assessors evaluated in terms of the same parameters, cross-sectional images obtained at the central, intermedial, and peripheral portions of one metal rod positioned in the right-angled, close to right-angled, and intermedial planes, and in order to compare the values at different sites, one neuroradiologist measured the horizontal and vertical diameters of each cut image. RESULTS: Three-dimensional images of all four phantoms were high quality in the close to right-angled and intermedial plane, but in the rotational and close to rotational plane were degraded. In particular, metal rod images obtained in the rotational plane were poor for all three items. In these two planes, image quality was better for the contrast rod than the metal rod, and at 200 and 250 Img/ml concentrations than at 300 and 150 Img/ml concentrations. There was no significant difference in image quality, nor in measured values of the diameter between cut images. CONCLUSION: A three-dimensional image was more distorted when a linear object was placed at a lesser angle to the rotational plane and when inherent X-ray attenuation was greater, a finding which must be closely related to the beam-hardening artifact. Distortion was least at 200-250 Img/ml of iodine concentration, the concentration thought to be most appropriate for in-vitro 3D angiography.
Angiography ; Angiography, Digital Subtraction ; Artifacts ; Imaging, Three-Dimensional ; Iodine ; Water